Exceptional management will be required in the NHS over the coming years as radical reforms to the health service are implemented, a new report has claimed.

The drastic overhaul of the health service will see the commissioning responsibilities handed over to GP consortia from strategic health authorities and primary care trusts, which will be axed.

The Nuffield Trust said that the new organisations emerging from the restructure will need to focus solely on managing the transition period. It added that if they try to take on too much work in their early stages, they would most likely come up against some serious challenges.

One of the demanding targets that have been imposed on the NHS by the government is to cut back £15bn to £20bn a year in 'efficiency savings'.

The report said: "To expect newly forming organisations to engage in anything more than effective management of the transition itself is highly ambitious.

"Indeed, business as usual in an NHS charged with making unprecedented 4% annual efficiency savings is a mammoth task."

The study is accompanied by the publication of surveys into GP and public attitudes towards the NHS and the reforms.

Two of the surveys were of GPs, with a sample size of more than 800 GPs per survey.

Fewer than a quarter (23%) of all the GPs agreed that the government's reforms would improve the quality of patient care.

Those GPs who were more actively involved in the new commissioning arrangements - with GPs taking control of 80% of the NHS budget - were more likely to say quality of care would improve.

Some 71% said the priority of new commissioning arrangements will be cost, with those who are most involved more likely to say this.

Overall, GPs said the changes were likely to result in less choice, particularly the number and type of procedures commissioned and referrals to hospital.